Should all electrocardiography be ambulatory?

Excerpt

Due to technological advances, electrocardiographic parameters can now be obtained by the lay public without going to a clinic or hospital. Consumer-based wearable devices that allow detection of atrial fibrillation (AF) and other arrhythmias are increasingly being used. Indeed, we have learned that early detection of AF can lead to earlier therapy and prevention of untoward thromboembolic complications. Another lesson learned is that population-based screening with such devices requires a sufficiently high pretest likelihood and a test with sufficient sensitivity and specificity to provide sensible outcomes. An important example in this context is the Apple Heart Study, which provided data on ~ 0.5 million persons who used a smartphone app for AF detection. As participants in that study overall reflected the ‘worried well’, with a very low pretest likelihood of AF, it is not surprising the test characteristics derived from this study were suboptimal [1]. …